PREDICTION OF THE BENEFICIAL RESPONSE TO THE FLUID LOAD: FROM THEORY TO PRACTICE
Keywords:
fluid load, prediction, intensive care unitAbstract
The accurate prediction of the beneficial response to the fluid load in hypotensive intensive care unit (ICU) patients is a routine task of the intensive care. In shock, fluid load should increase cardiac index of stroke volume in a substantial degree (10–15%) as well as to improve oxygen delivery and end-organ function. Notably, only about 50% of hypertensive patients respond to the fluid load with increased cardiac performance and this percentage may reduce dramatically in severely ill ICU patients several days after admission. The challenge of fluid management is very important since there is growing evidence that excessive fluid load in patients not responding to the increased preload can be harmful. The ineffective fluid load can result in hemodilution and decreased oxygen, increased fluid leakage, interstitial edema, and particularly, acute respiratory distress syndrome and multiple organ failure. Currently, multiple functional hemodynamic parameters and test are introduced to predict fluid responsiveness, allowing the prediction of response to the fluid administration. In the ventilated and paralysed patients without severe arrhythmia the pulse pressure, systolic pressure and stroke volume variability are of great value. However, the range of rigid requirements limits the accurate interpretation of these parameters to the settings of operation room, but not at ICU. In many spontaneously breathing ICU patients, the special tests can be used including passive leg raising, PEEP-test and mini-fluid load test. Standard fluid load test that is performed as a fast infusion of 5–10 ml/kg of fluids within 5– 30 min is probably most accurate, but irreversible maneuver sometimes failing to improve stroke volume. In this review, we briefly discuss the cardiopulmonary interactions, some of multiple functional hemodynamic parameters and selected tests used for daily assessment of fluid responsiveness. The numerous limitation and predictive value of the parameters are highlighted.
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